Healthcare Medicare Contract

HEALTHCARE MEDICARE CONTRACT

This Agreement is entered into between Provider Name: and Medicare Organization Name: (each a "Party" and collectively the "Parties").

Recitals and Effective Date

WHEREAS Provider is duly licensed and authorized to provide covered medical services to Medicare beneficiaries; and WHEREAS Payer administers Medicare benefits to eligible beneficiaries and desires to contract for the provision of services under the terms set forth herein. This Agreement is effective as of , (the "Effective Date").

Definitions

Capitalized terms used in this Agreement have the meanings assigned in this section. "Medicare Program" means the federal health benefit program commonly referred to as Medicare and associated regulations, rules, and manuals. "Covered Services" means those services for which Provider is authorized and competent to render and that are payable under the Medicare Program, subject to the exclusions and limitations set forth herein.

Term

The initial term of this Agreement shall commence on the Effective Date and shall continue for a period of months, unless earlier terminated as provided herein. Thereafter this Agreement shall automatically renew for successive one-year terms unless either Party provides written notice of non-renewal at least days prior to the then-current term expiration.

Scope of Services

Provider shall furnish Covered Services to Medicare beneficiaries in accordance with applicable professional standards, Medicare coverage policies, and this Agreement. Provider shall maintain credentials, licensure, and staffing sufficient to provide the services described below.

Compensation and Payment Terms

Payer shall reimburse Provider for Covered Services in accordance with the Medicare fee schedules, negotiated rates, and applicable program rules. Payment is subject to correct and timely submission of claims and verification of beneficiary eligibility.

Billing, Claims Submission and Provider Identifiers

Provider shall submit all claims in the form and format required by Payer and the Medicare Program. Claims must include Provider National Provider Identifier (NPI), Tax Identification Number (TIN), and any Medicare-assigned Provider Transaction Access Number (PTAN) or identification number.

Compliance with Medicare Program and Applicable Law

Provider and Payer shall comply with all applicable federal statutes and regulations governing the Medicare Program, including but not limited to rules regarding eligibility, coverage determinations, program integrity, and anti-kickback and fraud and abuse laws. Provider shall neither submit nor cause to be submitted claims that are false or fraudulent. Payer may suspend payments and seek recovery for overpayments discovered through audits or investigations.

Records, Audit and Access

Provider shall maintain complete and accurate medical, billing and financial records relating to services provided to beneficiaries and to claims submitted for a minimum of years or such longer period as required by law. Provider shall permit Payer, its designees, and authorized government representatives reasonable access to such records for inspection, audit, and photocopying.

Confidentiality and HIPAA

The Parties acknowledge obligations under the Health Insurance Portability and Accountability Act (HIPAA) and applicable privacy and security standards. Each Party shall implement appropriate administrative, technical, and physical safeguards to protect the privacy and security of protected health information.

Acknowledged

Indemnification and Insurance

Each Party shall indemnify, defend, and hold harmless the other Party from and against any claims, liabilities, losses, or expenses arising from that Party’s breach of this Agreement, negligent acts, or willful misconduct. Provider shall maintain professional liability insurance in amounts customary for the specialty and as required by applicable law.

Termination

Either Party may terminate this Agreement for cause upon written notice describing the nature of the breach and providing a cure period of days if the breach is curable. Either Party may terminate without cause upon providing at least days prior written notice to the other Party.

Notices

All notices and communications required or permitted under this Agreement shall be in writing and shall be delivered to the addresses set forth below by certified mail, overnight courier, or hand delivery.

Representations, Warranties and Certifications

Provider represents and warrants that it is duly licensed, in good standing, and authorized to provide the services described herein; that all information provided to Payer is true, accurate, and complete; and that Provider will comply with the Medicare Program rules and applicable law. Provider certifies that it has not been excluded from participation in any federal health care program.

Provider certifies that it is not currently excluded from participation in any federal health care program.

Additional Terms and Attachments

Provider Information

Provider Entity Type

Indicate Provider entity type:

Individual Provider Group Practice Facility Other

Miscellaneous Provisions

This Agreement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior agreements and understandings. Any amendment shall be in writing and signed by authorized representatives of both Parties. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

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